ACL rehabilitation is a long process that involves many different aspects that need to be addressed in order to have a successful return to sport.
Gaining strength is just one aspect in the rehab journey that needs to be considered.
I did lots of strength work in the gym and running for my ACL rehab. That should be enough, shouldn’t it?
A lot of people believe that once they are running with no pain, they are finished with rehab. However, the end stages of rehab are perhaps the most important, to help prepare you meet the demands of your sport. Completing of all areas of ACL rehab can help to reduce the chance of re-injury and increase the chance of a successful return to sport. In this article I will outline four areas of ACL rehab that are used in conjunction with strength training to get you back to where you want to be.
PROPRIOCEPTION for ACL rehabilitation
Proprioceptive training is important to help activate other structures in the knee joint that will produce compensatory muscle activation and ultimately assist with joint stability. Proprioception involves balance exercises to help teach your body where it is in space and hence give better stability and strength during unexpected or quick movements.
Completing proprioceptive exercises in the early-mid stages of ACL rehabilitation is important to build a good foundation before progressing to more challenging neuromuscular control exercises in the later stages (Wilk et al. 2012).
Below is an example of high level proprioception exercise, where the athlete is balancing on one leg on a bosu ball whilst throwing a ball. This reduces the focus on the knee, as the athlete has to react to catching the ball, whilst still creating a challenge for their balance and stability.
AGILITY for ACL rehabilitation
Agility drills are another important aspect of ACL rehab. It allows you to start to adjust to sports specific activities by breaking them down into bite size chunks. For example, changing direction, acceleration, deceleration, quick stops and take offs. Training this is important as there are few sports that simply involve running in a straight line continuously.
In the picture below this soccer player is using a ladder for quick feet drills. They use a grapevine movement to increase the twisting and turning motion at the knee joint. The focus here is on speed and accuracy. Other examples of agility exercises include slalom running, zig zag running and shuttle runs.
PLYOMETRICS for ACL rehabilitation
Plyometric activities involve explosive movements where muscles exert maximum force in short intervals of time, with the goal of increasing power (speed-strength). Plyometrics also work to improve neuromuscular control, which can become a learned skill that transfers to competitive play.
Research has shown us that when plyometric training is included in ACL rehab programs, athletes demonstrate improved movement quality, lower their risk of injury and have a higher chance of successfully returning to sport (Buckthorpe & Della Villa 2021).
Below is an example where the athlete does an explosive single hop for distance. Focus here is not only distance but also the control of taking off and landing. Other examples of plyometric exercises include scissor jumps, box jumps and hurdle hopping.
SPORTS SPECIFIC ACTIVITIES for ACL rehabilitation
Working closely with your physio is very important for a successful return to your sport. Your physio can work with you to develop a program that specifically relates to your sport, whether that is AFL, soccer, Netball, Hocky or rugby.
Your ACL works dynamically, to assist in stabilising the knee joint when you perform any twisting, turning or cutting motions. Therefore, it is important to train, when the time is right, in a way that mimics your sport’s functional demands.
In these later stages of rehab, your physio will be closely monitoring how your ACL repair side is going compared to your other side. Tests such as the hop for distance, are important to help us gauge when you are ready to return to sport. You can check out further information on ACL return to sport testing here.
Contact myPhysioSA today to talk to one of our specialised sports physios to help you get back to what you love.
Buckthorpe, M., & Della Villa, F. (2021). Recommendations for Plyometric Training after ACL Reconstruction – A Clinical Commentary. International journal of sports physical therapy, 16(3), 879–895. https://doi.org/10.26603/001c.23549
Wilk, K. E., Macrina, L. C., Cain, E. L., Dugas, J. R., & Andrews, J. R. (2012). Recent advances in the rehabilitation of anterior cruciate ligament injuries. The Journal of orthopaedic and sports physical therapy, 42(3), 153–171. https://doi.org/10.2519/jospt.2012.3741